Dev Tubo-ovaryan Apsede Başarılı Laparoskopik Tedavi: Zor Bir Olgu Sunumu

Year 2020, Volume: 4 Issue: 2, 56 - 59, 19.08.2020

Yavuz Şimşek

https://doi.org/10.46332/aemj.782779

Abstract

Tubo-ovaryan apse, pelvik inflamatuar hastalığın en ileri aşamasıdır ve pelvik enfeksiyonu olan kadınlarda ana ölüm nedenidir. Bu yazıda, kliniğimize kronik karın ağrısı ve 38 °C üzerinde ateş yakınması ile başvuran, ultrasonografide sağ adneksiyal bölgede 15x18 cm boyutlarında semisolid kitlesi bulunan bir hastayı sunduk. Hasta tubo-ovaryan apse tanısıyla yatırıldı ve geniş spektrumlu ampirik antibiyotik tedavisi başlandı. Buna karşın ateşin düşmemesi ve ağrının dinmemesi üzerine hasta laparoskopik cerrahiye alındı. Laparoskopide sağda tüp ve overi içine alan, üzeri ince barsak ve appendiks ile kaplı, aynı zamanda sigmoid kolonla iltisaklı apse görüldü. İntestinal segmentler nazikçe diseke edildi ve apse usulüne uygun olarak eksize edildi. Hasta postoperatif 5. günde sağlıkla taburcu edildi.

Keywords

laparoskopi, pelvik inflamatuar hastalık, tubo-ovaryan apse

Definitive Laparoscopic Treatment of Huge Tubo-ovarian Abscess: Report of a Difficult Case

Abstract

Tubo-ovarian abscesses are the end stage of pelvic inflammatory disease, and the main cause of mortality in women with pelvic infection. Here, we report a woman at 22 years of age, presenting with severe abdominal pain and fever >38 °Celcius and sonographically diagnosed with a semisolid adnexal mass with 15x18 cm in diameters on the right side. The woman was hospitalized with a diagnosis of tubo-ovarian abscess, and empiric broad-spectrum antibiotic therapy was started. However, pain and fever were not subsided. The patient underwent a laparoscopic surgery and a huge tubo-ovarian abscess covered by small intestines and appendix and adhered to the sigmoid colon was seen. Intestinal segments were gently dissected, and abscess, including the right ovary and the right tube, was excised appropriately without any complication. The patient was discharged on the 5th postoperative day with complete healing.

Keywords

laparoscopy, pelvic inflammatory disease, tubo-ovarian abscess

References

• 1. Curry A, Williams T, Penny ML. Pelvic inflammatory disease: diagnosis, management, and prevention. Am Fam Physician. 2019;100(6):357-364.
• 2. Rosen M, Breitkopf D, Waud K. Tubo-ovarian abscess management options for women who desire fertility. Obstet Gynecol Surv. 2009;64(10):681-689.
• 3. Buchweitz O, Malik E, Kressin P, Meyhoefer-Malik A, Diedrich K. Laparoscopic management of tubo-ovarian abscesses: retrospective analysis of 60 cases. Surg Endosc. 2000;14(10):948-950.
• 4. Chu L, Ma H, Liang J, et al. Effectiveness and adverse events of early laparoscopic therapy versus conservative treatment for tubo-ovarian or pelvic abscess: A single-center retrospective cohort study. Gynecol Obstet Invest. 2019;84(4):334-342.
• 5. Fouks Y, Cohen A, Shapira U, et al. Surgical intervention in patients with tubo-ovarian abscess: clinical predictors and a simple risk score. J Minim Invasive Gynecol. 2019; 26(3):535-543.